右美托咪定复合不同麻醉深度在老年全髋关节置换术患者中的麻醉效果及对术后谵妄的影响  

Effect of dexmedetomidine combined with different depth of anesthesia in elderly patients with total hip replacement and analysis of postoperative delirium risk factors

作　　者：王军[1] 杨垚 周丽丽[1] WANG Jun;YANG Yao;ZHOU Li-li(Department of Anesthesiology,the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan Sandong 250014,China)

机构地区：[1]山东中医药大学第二附属医院麻醉科,山东济南250014

出　　处：《临床和实验医学杂志》2023年第13期1448-1451,共4页Journal of Clinical and Experimental Medicine

基　　金：山东省自然科学技术项目(编号:2021KJ0286)。

摘　　要：目的 研究右美托咪定复合不同麻醉深度用于全髋关节置换术患者麻醉中的效果及对术后谵妄发生率的影响。方法 以回顾性分析为法,选取2017年1月至2022年1月入山东中医药大学第二附属医院的100例老年全髋关节置换术患者作为观察对象,参考不同脑电双频指数(BIS)划分为研究1组(BIS:40~49,n=33)、研究2组(BIS:50~59,n=37)和对照组(BIS:60~69,n=30)。比较3组患者手术前后简易精神状态量表(MMSE)评分、血清神经元特异性烯醇化酶(NSE)、S100β蛋白浓度与术后72 h内谵妄发生率。结果 术后72 h, 3组患者MMSE评分均明显低于手术前,研究2组的MMSE评分为(27.56±1.22)分,明显高于研究1组[(26.59±1.37)分]和对照组[(26.74±1.58)分],差异均有统计学意义(P<0.05)。术后72 h, 3组患者血清NSE、S100β蛋白浓度均明显高于手术前,研究2组血清NSE、S100β蛋白浓度分别为(9.36±1.69)、(0.60±0.14)μg/L,均明显低于研究组1组[(10.29±2.07)、(0.79±0.24)μg/L]和对照组[(11.21±1.88)、(0.81±0.23)μg/L],差异均有统计学意义(P<0.05)。研究2组术后谵妄发生率为2.70%,明显低于研究1组(24.24%)和对照组(30.00%),差异有统计学意义(P<0.05)。结论 老年全髋关节置换术患者麻醉中,右美托咪定复合麻醉深度以BIS 50~59范围为最佳,可减轻患者术后意识障碍,改善血清NSE及S100β蛋白浓度,并减少谵妄发生风险。Objective To investigate the effects of dexmedetomidine combined with different anesthesia depths in elderly patients undergoing total hip replacement and the effects on postoperative delirium.Methods In retrospective analysis,100 elderly patients with total hip replacement admitted to the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2017 to January 2022 were observed and divided into study group 1(BIS:40-49,n=33)and study group 2(BIS:50-59,n=37)and control group(BIS:60-69,n=30)based on different bispectral index(BIS).The score of the Simple Mental State Scale(MMSE),serum neuron-specific enolase(NSE),S100βprotein and the incidence of delirium 72 h after operation were compared among the three groups.Results The MMSE score 72 h after operation of the three groups were significantly lower than those before operation,MMSE score 72 h after operation in study group 2 was(27.56±1.22)points,which was significantly higher than those in study group 1[(26.59±1.37)points]and control group[(26.74±1.58)points],and the differences were statistically significant(P<0.05).Serum concentrations of NSE and S100βwere significantly increased 72 h after operation,serum concentrations of NSE and S100βin study group 2 were(9.36±1.69),(0.60±0.14)μg/L,which were significantly lower than those in study group 1[(10.29±2.07),(0.79±0.24)μg/L]and control group[(11.21±1.88),(0.81±0.23)μg/L]72 h after operation,and the differences were statistically significant(P<0.05).The incidence of postoperative delirium in study group 2 was 2.70%,which was significantly lower than those in study group 1(24.24%)and control group(30.00%),and the differences were statistically significant(P<0.05).Conclusion In elderly patients undergoing total hip replacement,the depth of combined anesthesia with tomidine in the range of 50-59 is the best,which can alleviate postoperative disturbance of consciousness,improve serum concentrations of NSE and S100β,and reduce the risk of delirium.

关 键 词：右美托咪定 全髋关节置换术 麻醉深度 麻醉效果 谵妄 

分 类 号：R614[医药卫生—麻醉学]